Chapter Nine
Dr. Ralston entered the room with a clipboard. Ralston’s expression was stoic when she asked Marybeth to please sit down.
Fearing the worst, Marybeth felt her legs go weak for a moment. Then she gathered her composure and sat down opposite Dr. Ralston.
“I’ve studied the results of the CT scan and consulted with my colleagues here,” Ralston said. “We think we’ve come up with the best plan of care for your husband, but it involves risks you need to be aware of before we proceed with anything.”
Marybeth nodded for the doctor to go on.
She’d spent the last several hours seated next to Joe.
The left half of his head was heavily bandaged, and all she could see of his face was his closed right eye, cheek, and mouth.
He appeared to be sleeping the whole time and his breath was steady and gentle.
She’d reached under the sheets to hold his limp hand, and at one point she’d leaned over him.
He smelled of adhesive tape and disinfectant.
She’d whispered, “I love you, Joe. You know that.”
Of course, there had been no response of any kind. She wondered if he’d heard her. She hoped so.
Was he dreaming in there?
—
Dr. Ralston placed the clipboard on the table between them. The top sheet was a printout of a generic face and head. She pulled a black felt-tip pen from her smock and drew an X about an inch and a half above the right eyebrow.
“This is approximately where the bullet entered,” she said. “It came in from the front and it penetrated his skull right here. It didn’t exit the skull, however. It’s still in there.”
“What exactly does that mean?” Marybeth asked with a dry mouth.
Dr. Ralston removed the top sheet to show a second figure of a head in profile. Inside the profile was an oblong outline of a human brain. She drew a series of dashes from the entry going up through the top front part of the brain, and she made another X on the underside of the skull.
“The bullet went through part of the frontal lobe in an upward trajectory until it stopped here,” she said. “It is lodged within the meninx as we suspected. There doesn’t look to be any damage to the top of the skull. This might be quite a lucky break, Mrs. Pickett.”
“How so?”
Dr. Ralston tapped on the line of the bullet path. “If the trajectory of the bullet had been going down instead of up, it would have likely plowed through several more lobes of the brain. Meaning it would have been instantly fatal.
“But in this instance, whether the bullet itself was deflected by the windshield or your husband was looking up when the impact came—or both—the trajectory went upward. I’m guessing it was the windshield.
The glass retarded the velocity of the bullet and possibly deflected it, but we’ll never know for sure.
And because the velocity of the bullet was decreased, it didn’t go through the brain and create an exit wound outside his skull.
That might have been fatal as well because of the internal and external hemorrhaging. ”
“This almost sounds like good news, Doctor.”
Dr. Ralston held up her palm. “That might be overstating things. What it means is that we might have a better percentage chance that he survives than we thought when he was brought in. But I can’t guarantee it. I need you to understand that.”
Marybeth nodded that she did. Then she glanced over at Joe in his bed. “Can he hear us?”
“No.”
“Are you sure?”
“No. But it’s unlikely.”
Dr. Ralston went on to detail the surgery required to remove the bullet by going through the top of the skull into the meninx. She went on to say how many things could still go wrong, and that there was no way to definitively say how much damage had been done to the brain by the path of the bullet.
“Removing the bullet could start massive hemorrhaging in itself,” she said.
“Sometimes when you disturb the status quo, it’s like a house of cards suddenly falling down.
The bullet itself might be plugging the rupture of important blood vessels and removing it could cause them to hemorrhage severely. We won’t know until we go in.”
Marybeth absorbed that, then asked, “I know you doctors like to go by percentages in surgery. Knowing what you know, what odds would you give for a successful operation?”
“Fifty-five percent,” Dr. Ralston responded.
“That’s all?”
“I might be a touch conservative, but that’s what I’ll go with.”
“Why so low?” Marybeth asked.
“Because there are just so many variables—some we know, and some we won’t know until they happen.
Although his vital signs are stable right now, this is brain surgery, after all.
We could do a successful surgery and remove the bullet, but a relapse could occur when we slowly bring him out of the coma.
Mental activity and increased blood flow could wreak havoc in the damaged areas.
We’ll have to monitor that very carefully. ”
“What part of the brain might be damaged?” Marybeth asked.
Dr. Ralston touched the top of her forehead just below her hairline. “The top of the frontal lobe. We didn’t find any additional damage beyond that.”
Marybeth asked what injury to the frontal lobe could mean.
“As you probably know,” Dr. Ralston said, “every part of the brain has distinctive functions. The frontal lobe is in charge of thinking, planning, decision-making, and maintaining an attention span. Other lobes control movement, speech, smell, memory, and everything else. So again, it’s fortunate that the bullet only nicked the frontal lobe. ”
“But that sounds terrible,” Marybeth said. “How could the damage affect him if he comes out of this?”
Dr. Ralston sat back and sighed. She said, “It’s impossible to say at this point. There have been a lot of advances in brain science, but we aren’t far enough along to make any kind of prediction about how your husband will be affected by this—if everything goes well.
“Let me give you a couple of examples I’m very familiar with,” the doctor said.
“There’s the case of Juan Martinez, who was a twenty-two-year-old gang member here in Billings.
They brought him in six or seven years ago with a gunshot wound to the head similar to what we’re talking about here.
The bullet passed through the frontal lobe and exited through the top of his skull.
I was on the surgery team, and we were able to patch him up the best we could.
“I didn’t know Juan before he was shot, but from what we learned of him, he was known to be a pretty bad customer, with a long rap sheet even at his young age, including an arrest for attempted murder.
He was covered in gang tattoos. But when you have a patient like that, you can’t make judgments.
Our job was to save his life and provide the best care possible, which we did.
“He recovered well,” Dr. Ralston said. “He was young and strong, and he was talking a mile a minute the last few days he was in the hospital. He told us how grateful he was that we saved his life. But when his friends—mostly other gang members—came to visit him, they told us Juan was like a different person, that his personality had changed. Later, we found out he’d enrolled in community college and had learned to play the piano. Imagine that.”
“So he went from a being a bad person to a good person?” Marybeth asked.
“Apparently,” Dr. Ralston said. “But it didn’t work out for him in the end.
The gang didn’t like it that he left them, and apparently there were a bunch of old grievances.
Juan was killed in a drive-by shooting a year after he was released from the hospital.
He was on his way to college when they got him.
“Then there’s the case of Phil Gage,” Dr. Ralston said.
“He was a thirty-two-year-old husband and father of two little ones, and he worked construction over in Red Lodge. One day, he was going up a ladder when another worker was coming down. This other worker was holding a nail gun at his side and Phil climbed right up into it and it discharged. The nail gun shot a sixteen-penny nail through Phil’s skull into his frontal lobe.
When they brought him to the emergency room, the point of the nail was sticking out of his face right here,” she said, indicating a spot just below her left eye.
“We put Mr. Gage into an induced coma, just like we did for your husband, and we removed the nail. Phil recovered nicely. He had such a wonderful family, and they were a delight when they came to visit him. His two little daughters were dolls, and they gave us hand-drawn thank-you notes. Mrs. Gage told us that Phil was the best husband and father in the world, and that they were very devout Mormons who didn’t drink, smoke, or party.
Phil’s employer told us he was grateful that he hadn’t lost the best worker he’d ever had. ”
Marybeth felt her stomach tighten. She was dreading what would come next.
“A year after he was released from here, Phil Gage beat his wife almost to death and he went on the run with a seventeen-year-old runaway he’d met at a bar in Red Lodge.
We later learned that he’d been fired from his construction job because he’d become belligerent and insubordinate, and he kept getting into fistfights with other employees.
“When the police finally located him at a bar in Hardin, Phil shot one of the officers and they shot Phil a half dozen times. They brought him here for emergency care, and I recognized him right away. It was Phil Gage on that operating table, but everything about him was different. He was surly, profane, and vicious. He’s divorced now, and he’s serving time at the state prison in Deer Lodge. ”
When Dr. Ralston read the look on Marybeth’s face, she said, “Oh, I’m sorry. I might have said too much. What you need to keep in mind is that it’s possible your husband may have no changes at all, or some changes in his personality. It can go either way. There is no way to know at this point.”
She went on to brief Marybeth on the next steps: reducing his medication slightly to stimulate brain function, keeping his blood pressure stable, and preparing for surgery when his GCS level was adequate.
Marybeth half heard what the doctor was saying. Mostly, she wondered what her life would be like after the surgery, provided that Joe recovered.
Would he start playing the piano?
Or would he chase her through their house with a baseball bat?
With those questions in mind, Marybeth signed the paperwork authorizing surgery. Dr. Ralston rose, patted Marybeth gently on her shoulder, and left the room.
—
As she did, a call came through on Marybeth’s phone from her mother, Missy. Marybeth stared at the screen for a moment, weighing whether or not she wanted to answer it. She sighed, punched the icon, and said, “Yes?”
“Marybeth, I just heard,” Missy said.
“Thank you for calling.”
“Sweetie, I’ve been thinking about it. You can look at this as a tragedy or an opportunity to start a new life.”
“What?”
“That’s what I’ve always done, you know. I look past a bad situation and move on. It’s worked for me, Marybeth.”
Marybeth held the phone out and stared at it for a moment, trying to imagine the monster on the other end. She pictured Missy sitting on her love seat in her home in Jackson Hole with a martini in front of her. The woman could barely contain her glee.
“Mom, Joe is not dead,” Marybeth said.
“He isn’t? I heard he got shot in the head.”
“He did, but we’re in the hospital. He’s very much alive, and they’re going to do surgery.”
There was a pause before Missy said, “Oh.”
“Do not call me again,” Marybeth said before angrily terminating the connection.
—
Because there had been so many texts and calls in regard to Joe’s condition from so many people—Governor Rulon, Sheriff Sondergard, the new director of the Game and Fish Department, and what seemed like half of Twelve Sleep County—Marybeth decided to write a social media post that would address Joe’s status.
The idea went against her instincts because she was not a Facebook person and she disliked the idea of offering up their privacy like that.
But she couldn’t think of any other way of providing an update to so many people, many of whom were close friends.
Marybeth decided to leave out everything Dr. Ralston had told her about the condition of the other patients who’d had similar injuries.
But when she activated her phone, she saw the text from Lucy:
Sheridan has been arrested and she’s in the county jail. We’re headed there now to try and spring her.